Bioethics Blogs

Rethinking Dying and Alzheimer’s Disease: How Do We Plan For Future Care?


Alzheimer’s is a progressive disease that over time robs the
person of their selfhood. Eventually the advanced Alzheimer’s patient lives in
a world of discrete, fleeting moments. The former self is obliterated and all
of the personal connections to former loved ones are forever lost. The current
self or the “now-self” is self-contained in each passing moment so there are as
many selves as there are moments. From the onset of diagnosis a patient may
live for as few as 3 years to as many as 10 or more. Much depends on the age of
the patient and the comorbid conditions. But it is important to make clear:
Alzheimer’s is a terminal disease for which there is no effective treatment to
abate the progressive symptoms or to prevent or slow the mental and physical
dying process. Though death does not occur until the whole human organism
ceases to function, death must also, at least partly, be understood as the
gradual dying of that unique personal self. This includes the higher brain
functions that allow humans to be their uniquely personal selves, with
personalities, habits, loves, careers, causes, values, characters, and so on. When
these aspects of the patient begin to wane, there begins the gradual loss of “critical
interests”—those personal aspects of one’s life one controls as an autonomous,
social human being and moral agent.

Yet, the loss of critical interests or what we might call
rational selfhood, do not necessarily entail the simultaneous loss of “experiential
interests” that are connected to purely biological functions.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.